| 1. |
- Halling, Anders, et al.
(author)
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General health and tobacco habits among middle-aged Swedes
- 2007
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In: European Journal of Public Health. - 1101-1262 .- 1464-360X. - 1101-1262 ; 17:2, s. 151-154
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Journal article (peer-reviewed)abstract
- Background: Convincing scientific evidence exists that smoking has devastating effects on health. The use of smokeless tobacco (snuff) as a tobacco habit has been reported to be considerably less harmful, and has been suggested as an aid to smoking cessation, among other things. Methods: Cross-sectional data on general health and tobacco habits were obtained through a self-administered mail questionnaire in 2002 representing 50-year-old (n = 6236) and 60-year-old (n = 6232) Swedes in two counties. Participation rates were 70.2 and 75.7% in the both age cohorts, respectively. Of all participants 46.2% were male and 53.8% female. A general health index encompassing five items (score 0-5) was designed, with the best general health attributed to those scoring 5. Results: Male daily smokers accounted for 15.6% of the 50-year-olds and 18.7% of the 60-years-olds compared with 21.1 and 16.6%, respectively, for females. Corresponding figures for daily snuffing were 21.1 and 11.9% for men and 1.7 and 0.4% for women. When adjusting for age, sex, place of living, social network, education, and marital status, and related to subjects who never used tobacco, 'best general health' score 5, significant differences were found for ex-smokers (OR 0.82; 95% CI 0.74-0.90; P < 0.001) and ex-snuffers (OR 0.74; 95% CI 0.61-0.90; P < 0.01). Conclusion: Those who have stopped smoking or snuffing seem to be in a vulnerable condition with respect to general health and in need of extra support and health-promoting activities.
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| 2. |
- Halling, Anders, et al.
(author)
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General health and tobacco habits among middle-aged Swedes
- 2007
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In: European Journal of Public Health. - : Oxford University Press. - 1101-1262 .- 1464-360X. ; 17:2, s. 151-154
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Journal article (peer-reviewed)abstract
- Background: Convincing scientific evidence exists that smoking has devastating effects on health. The use of smokeless tobacco (snuff) as a tobacco habit has been reported to be considerably less harmful, and has been suggested as an aid to smoking cessation, among other things. Methods: Cross-sectional data on general health and tobacco habits were obtained through a self-administered mail questionnaire in 2002 representing 50-year-old (n = 6236) and 60-year-old (n = 6232) Swedes in two counties. Participation rates were 70.2 and 75.7% in the both age cohorts, respectively. Of all participants 46.2% were male and 53.8% female. A general health index encompassing five items (score 0-5) was designed, with the best general health attributed to those scoring 5. Results: Male daily smokers accounted for 15.6% of the 50-year-olds and 18.7% of the 60-years-olds compared with 21.1 and 16.6%, respectively, for females. Corresponding figures for daily snuffing were 21.1 and 11.9% for men and 1.7 and 0.4% for women. When adjusting for age, sex, place of living, social network, education, and marital status, and related to subjects who never used tobacco, 'best general health' score 5, significant differences were found for ex-smokers (OR 0.82; 95% CI 0.74-0.90; P < 0.001) and ex-snuffers (OR 0.74; 95% CI 0.61-0.90; P < 0.01). Conclusion: Those who have stopped smoking or snuffing seem to be in a vulnerable condition with respect to general health and in need of extra support and health-promoting activities.
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| 3. |
- Zielinski, Andrzej, et al.
(author)
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Differences in referral rates to specialised health care from four primary health care models in Klaipeda, Lithuania
- 2008
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In: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 9
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Journal article (peer-reviewed)abstract
- Background: Lithuanian primary health care (PHC) is undergoing changes from the systems prevalent under the Soviet Union, which ensured free access to specialised health care. Currently four different PHC models work in parallel, which offers the opportunity to study their respective effect on referral rates. Our aim was to investigate whether there were differences in referrals rates from different Lithuanian PHC models in Klaipeda after adjustment for co-morbidity. Methods: The population listed with 18 PHC practices serving inhabitants in Klaipeda city and region (250 070 inhabitants). Four PHC models: rural state-owned family medicine practices, urban privately owned family medicine practices, state-owned polyclinics and privately owned polyclinics. Information on listed patients and referrals during 2005 from each PHC practice in Klaipeda was obtained from the Lithuanian State Sickness Fund database. The database records included information on age, gender, PHC model, referrals and ICD 10 diagnoses. The Johns Hopkins ACG Case-Mix system was used to study co-morbidity. Referral rates from different PHC models were studied using Poisson regression models. Results: Patients listed with rural state-owned family medicine practices had a significantly lower referral rate to specialised health care than those in the other three PHC models. An increasing co-morbidity level correlated with a higher physician-to self-referral ratio. Conclusion: Family medicine practices located in rural-, but not in urban areas had significantly lower referral rates to specialised health care. It could not be established whether this was due to organisation, training of physicians or financing, but suggests there is room for improving primary health care in urban areas. Patient's place of residence and co-morbidity level were the most important factors for referral rate. We also found that gatekeeping had an effect on the referral pattern with respect to co-morbidity level, so that those with a physician referral were more likely to have had higher co-morbidity.
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| 4. |
- Bennet, Louise, et al.
(author)
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Clinical appearance of erythema migrans caused by Borrelia afzelii and Borrelia garinii : effect of the patient´s sex
- 2006
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In: Wiener Klinische Wochenschrift. - : SPRINGER WIEN. - 0043-5325 .- 1613-7671. ; 118:17-18, s. 531-537
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Journal article (peer-reviewed)abstract
- Aim: The aim in this survey was to study the clinical characteristics of infections caused by Borrelia genospecies in patients with erythema migrans where Borrelial origin was confirmed by polymerase chain reaction. The aim was also to study factors influencing the clinical appearance of erythema migrans. Methods: The study was conducted in southern Sweden from May 2001 to December 2003 on patients 18 years and older attending with erythema migrans at outpatient clinics. All erythema migrans were verified by polymerase chain reaction, photographed and categorized into “annular” or “non-annular” lesions. A logistic regression model was used to analyze relations between the appearance of the erythema migrans (i.e., annular or non-annular) and factors that influenced its clinical appearances. Results: A total of 118 patients, 54 women (45.8%) and 64 men (54.2%), fulfilled the inclusion criteria. Of these patients, 74% were infected by B. afzelii, 26% by B. garinii ( p < 0.001). A total of 45% (38/85) of the erythema migrans were annular, 46% (39/85) were non-annular and 9.4% (8/85) were atypical. For men infected by B. afzelii the odds ratio of developing non-annular erythema migrans was 0.09 (95% CI: 0.03 - 0.33) in comparison with women with the same infection. Conclusions: In this prospective study of a large series of erythema migrans, where infecting genospecies were confirmed by polymerase chain reaction, the sex of patients infected with B. afzelii had a strong influence on the appearance of the rash. Patients infected by B. garinii more often had non-annular erythema migrans and a more virulent infection with more individuals presenting with fever, raised levels of C-reactive protein and seroreactivity in the convalescence sera.
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| 5. |
- Bennet, Louise, et al.
(author)
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Increased incidence of Lyme borreliosis in southern Sweden following mild winters and during warm, humid summers.
- 2006
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In: European Journal of Clinical Microbiology and Infectious Diseases. - : SPRINGER. - 0934-9723 .- 1435-4373. ; 25:7, s. 426-432
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Journal article (peer-reviewed)abstract
- The aim of the present study was to investigate the long-term incidence rate of Lyme borreliosis and, additionally, to determine whether a correlation exists between climatic factors and summer-season variations in the incidence of Lyme borreliosis. Climatic variability acts directly on tick population dynamics and indirectly on human exposure to Lyme borreliosis spirochetes. In this study, conducted in primary healthcare clinics in southeastern Sweden, electronic patient records from 1997-2003 were searched for those that fulfilled the criteria for erythema migrans. Using a multilevel Poisson regression model, the influence of various climatic factors on the summer-season variations in the incidence of erythema migrans were studied. The mean annual incidence rate was 464 cases of erythema migrans per 100,000 inhabitants. The incidence was significantly higher in women than in men, 505 and 423 cases per 100,000 inhabitants, respectively (p<0.001). The summer-season variations in the erythema migrans incidence rate correlated with the monthly mean summer temperatures (incidence rate ratio 1.12; p<0.001), the number of winter days with temperatures below 0 degrees C (incidence rate ratio 0.97; p<0.001), the monthly mean summer precipitation (incidence rate ratio 0.92; p<0.05), and the number of summer days with relative humidity above 86% (incidence rate ratio 1.04; p<0.05). In conclusion, Lyme borreliosis is highly endemic in southeastern Sweden. The climate in this area, which is favourable not only for human tick exposure but also for the abundance of host-seeking ticks, influences the summer-season variations in the incidence of Lyme borreliosis.
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| 6. |
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| 7. |
- Halling, Anders, et al.
(author)
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Concordance between elderly patients' understanding of and their primary healthcare physician's diagnosis of heart failure
- 2006
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In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 24:2, s. 110-114
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Journal article (peer-reviewed)abstract
- Objective. The objective was to study primary healthcare patients' understanding of their diagnosis of heart failure (HF), using patients treated for diabetes mellitus (DM) as a comparative group. Design. A cross-sectional community based study. Setting. Karlskrona community situated on the Swedish south-east coast with 60 600 inhabitants. Subjects. A total of 1402 subjects, aged 60 - 96 years in 10 age cohorts, selected randomly from the national population registry participating in the Swedish National study on Ageing and Care - Blekinge. Main outcome measures. Understanding of diagnosis of HF or DM in primary healthcare. Prevalence of cognitive impairment. Results. In all, 39.8% of patients with a diagnosis of HF treated in primary healthcare and 97.1% of patients with DM had an understanding of their respective diagnosis. Cognitive impairment was significantly more prevalent in the groups of patients treated for HF ( OR 1.9, 95% CI 1.2 to 3.0) and DM ( OR 1.8, 95% CI 1.1 to 3.1), when compared with those not treated for either HF or DM. The odds ratio for understanding of diagnosis was 0.013 ( 95% CI 0.003 to 0.052, p< 0.001) in patients treated for HF, compared with patients treated for DM, when adjusted for the subject's age, sex, and cognitive function. Conclusion. In this study it was shown that patients' understanding of their diagnosis was highly dependent on diagnosis, independently of age, sex, or cognitive function. The results suggest that there is room for improvement of care in primary healthcare, to increase HF patients' understanding of their diagnosis.
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| 8. |
- Johansson, Anders, 1957, et al.
(author)
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Differences in four reported symptoms related to temporomandibular disorders in a cohort of 50-year-old subjects followed up after 10 years
- 2008
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In: Acta Odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 66:1, s. 50-57
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Journal article (peer-reviewed)abstract
- Objective. To assess possible changes in the prevalence of four temporomandibular disorder (TMD) symptoms reported by subjects at age 50 and again 10 years later. Material and methods. Identical questionnaires were sent out in 1992 and in 2002 to all subjects born in 1942 and living in two Swedish counties. Of those who answered the four questions on TMD symptoms in 1992, 74% responded in 2002 (N=4639). The response alternatives were dichotomized into two groups: 1) No problems, and 2) some, rather severe and severe problems. Results. The mean prevalence of TMD-related symptoms reflected small and mainly non-significant changes, whereas the prevalence of reported bruxism was significantly greater at age 60 than at age 50. Among those with no TMD symptoms at age 50, 5-7 % of the men and 8-9% of the women reported symptoms at age 60. Of those reporting one or more TMD symptoms at age 50, 47-65 % of the men and 40-48 % of the women had no symptoms 10 years later. There was a significant and markedly increased risk of reporting TMD symptoms and bruxism (OR > 10) at age 60 among those who had symptoms at age 50. Conclusions. The mean prevalence of reported TMD symptoms was relatively consistent from age 50 to age 60. The group reporting symptoms at the first examination were highly likely still to have the symptoms 10 years later. However, approximately half of the subjects with TMD symptoms at age 50 reported no symptoms at age 60.
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| 9. |
- Johansson, Anders, 1957, et al.
(author)
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Risk factors associated with symptoms of temporomandibular disorders in a population of 50- and 60-year-old subjects
- 2006
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In: J Oral Rehabil. ; 33, s. 473-481
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Journal article (peer-reviewed)abstract
- The aims were first to investigate, by means of a mail questionnaire, variables from three domains (1) socio-economic attributes, (2) general and oral health, and (3) dental attitudes and behaviours in a large sample of 50- and 60-year-old subjects, and second to compare subjects with or without reported TMJ pain with respect to these variables. In 2002, a questionnaire was mailed to all 50- and 60-year-old subjects in two Swedish counties, Örebro and Östergötland (n=17138; n50=8878; n60=8260). Individuals not responding within two weeks were given a reminder. If still not answering, a new questionnaire was sent. The final response rate was 72.8% (n=12468). The reported responses to questions regarding “pain in the TMJ region” and “difficulty to open the mouth wide” were dichotomised into two groups, 1) no TMD symptoms, and 2) some, rather great, or severe TMD symptoms. Striking differences in demographic, occupational, general and oral health conditions were found between the groups with and without TMD symptoms. The strongest risk indicator for both pain and dysfunction was reported bruxism. Women, younger subjects (50 years old) and blue collar workers were significantly more prevalent in the TMD symptom groups. Variables related to impaired general and oral health were more common in the groups with reported TMD problems, whereas satisfaction with received dental care and with teeth was lower. Individuals with reported TMD symptoms differed significantly from those without TMD symptoms in socio-economic attributes, general and oral health symptoms, dental conditions and satisfaction with their teeth.
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| 10. |
- Johansson, Anders, et al.
(author)
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Risk factors associated with symptoms of temporomandibular disorders in a population of 50- and 60-year-old subjects
- 2006
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In: Journal of Oral Rehabilitation. - : Wiley. - 1365-2842 .- 0305-182X. ; 33:7, s. 473-481
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Journal article (peer-reviewed)abstract
- The aims of this study were first to investigate, by means of a mail questionnaire, variables from three domains: (i) socio-economic attributes; (ii) general and oral health; and (iii) dental attitudes and behaviours in a large sample of 50- and 60-year-old subjects, and second to compare subjects with or without reported temporomandibular joint (TMJ) pain with respect to these variables. In 2002, a questionnaire was mailed to all 50- and 60- year-old subjects in two Swedish counties, Örebro and Östergötland (n =17 138; n 50 = 8878; n 60 = 8260). Individuals not responding within 2 weeks were given a reminder. If still not answering, a new questionnaire was sent. The final response rate was 72.8% (n = 12 468). The reported responses to questions regarding ‘pain in the TMJ region’ and ‘difficulty to open the mouth wide’ were dichotomized into two groups: (i) no temporomandibular disorders (TMD) symptoms; and (ii) some, rather great or severe TMD symptoms. Striking differences in demographic, occupational, general and oral health conditions were found between the groups with and without TMD symptoms. The strongest risk indicator for both pain and dysfunction was reported bruxism. Women, younger subjects (50 years old) and bluecollar workers were significantly more prevalent in the TMD symptom groups. Variables related to impaired general and oral health were more common in the groups with reported TMD problems, whereas satisfaction with received dental care and wlth teeth was lower. Individuals with reported TMD symptoms differed significantly from those without TMD symptoms in socio-economic attributes, general and oral health symptoms, dental conditions and satisfaction with their teeth.
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